Статья посвящена мало изученной в нашей стране форме ботулизма, регистрируемой исключительно у младенцев. Принципиальное отличие данной формы от наиболее распространенного пищевого ботулизма состоит в том, что младенцы инфицируются путем заглатывания спор с последующим их прорастанием, колонизацией кишечника и выработкой ботулотоксина in situ, что приводит к развитию опасных для жизни вялых параличей. C учетом особенностей патогенеза клинические проявления младенческого ботулизма имеют некоторые особенности, что обсуждается авторами. Особое внимание уделяется эпидемиологии и факторам риска развития заболевания. В статье подробно обсуждаются вопросы диагностики и лабораторной верификации этиологии заболевания. Представлены современные данные по лечению младенческого ботулизма.
The article is devoted to a form of botulism that has been little studied in our country and is registered exclusively in infants. The fundamental difference between this form and the most common foodborne botulism is that infants become infected by ingestion of spores, followed by their germination, colonization of the intestines and production of botulinum toxin in situ, which leads to the development of life-threatening flaccid paralysis. Taking into account the peculiarities of pathogenesis, the clinical manifestations of infant botulism have some features, which are discussed by the authors. Particular attention is paid to the epidemiology and risk factors for the development of the disease. The article discusses in detail the issues of diagnosis and laboratory verification of the etiology of the disease. Current data on the treatment of infant botulism are presented.
1. Ибатуллин Р.А., Магжанов Р.В. Случай ятрогенного ботулизма при ботулинотерапии в клинической практике. Терапевтический архив. 2018;90(11):102-4 [Ibatullin RA, Magjanov RV. Case of iatrogenic botulism after botulinotherapy in clinical practice. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(11):102-4 (in Russian)]. DOI:10.26442/terarkh20189011102-104
2. Малов В.А., Малеев В.В., Покровский В.И. Ботулинотерапия и ятрогенный ботулизм: взгляд инфекциониста на проблему. Инфекционные болезни. 2019;17(4):55-61 [Malov VA, Maleyev VV, Pokrovsky VI. Botulinum toxin therapy and iatrogenic botulism: view of an infectious disease specialist. Infectious Diseases. 2019;17(4):55-61 (in Russian)]. DOI:10.20953/1729-9225-2019-4-55-61
3. Никифоров В.В. Ботулизм. M.: Эко-Вектор, 2024 [Nikiforov VV. Botulizm. Moscow: Eko-Vektor, 2024 (in Russian)].
4. Sobel J. Botulism. Clin Infect Dis. 2005;41(8):1167-73. DOI:10.1086/444507
5. Harris RA, Anniballi F, Austin JW. Adult Intestinal Toxemia Botulism. Toxins (Basel). 2020;12(2):81. DOI:10.3390/toxins12020081
6. Андреева А.А., Кутищева И.А., Мартынова Г.П., и др. Случай ботулизма у ребенка грудного возраста. Детские инфекции. 2020;19(2):64-6 [Andreeva AA, Kutishcheva IA, Martynova GP, et al. Case of infant botulism. Children's Infections. 2020;19(2):64-6 (in Russian)]. DOI:10.22627/2072-8107-2020-19-2-64-66
7. King LA, Popoff MR, Mazuet C, et al. [Infant botulism in France, 1991–2009. Arch Pediatr. 2010;17(9):1288-92 (in French)]. DOI:10.1016/j.arcped.2010.06.010
8. López-Laso E, Roncero-Sánchez-Cano I, Arce-Portillo E, et al. Infant botulism in Andalusia (Southern Spain). Eur J Paediatr Neurol. 2014;18(3):321-6. DOI:10.1016/j.ejpn.2013.12.008
9. Vosloo MN, Opperman CJ, Geyer HDW, et al. First confirmed case of infant botulism in Africa, caused by a dual-toxin-producing Clostridium botulinum strain. Int J Infect Dis. 2021;103:164-6. DOI:10.1016/j.ijid.2020.11.131
10. Nga TT, Hoang LH, Trang LT, et al. First confirmed case of infant botulism caused by Clostridium botulinum type A(B) in a 10-month-old infant in Hanoi, Vietnam. IJID Reg.
2022;5:18-20. DOI:10.1016/j.ijregi.2022.08.003
11. Goldberg B, Danino D, Levinsky Y, et al. Infant Botulism, Israel, 2007–2021. Emerg Infect Dis. 2023;29(2):235-41. DOI:10.3201/eid2902.220991
12. Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med. 1976;295(14):770-2. DOI:10.1056/NEJM197609302951407
13. Arnon SS, Werner SB, Faber HK, Farr WH. Infant botulism in 1931. Discovery of a misclassified case. Am J Dis Child.
1979;133(6):580-2. DOI:10.1001/archpedi.1979.02130060020002
14. Nevas M, Lindström M, Virtanen A, et al. Infant botulism acquired from household dust presenting as sudden infant death syndrome. J Clin Microbiol. 2005;43(1):511-3. DOI:10.1128/JCM.43.1.511-513.2005
15. Dilena R, Pozzato M, Baselli L, et al. Infant botulism: checklist for timely clinical diagnosis and new possible risk factors originated from a case report and literature review. Toxins (Basel). 2021;13(12):860. DOI:10.3390/toxins13120860
16. Poulain B, Popoff MR. Why Are Botulinum Neurotoxin-Producing Bacteria So Diverse and Botulinum Neurotoxins So Toxic? Toxins (Basel). 2019;11(1):34. DOI:10.3390/toxins11010034
17. Rossetto O, Montecucco C. Tables of Toxicity of Botulinum and Tetanus Neurotoxins. Toxins (Basel). 2019;11(12):686. DOI:10.3390/toxins11120686
18. Halpin AL, Khouri JM, Payne JR, et al. Type F Infant Botulism: Investigation of Recent Clusters and Overview of This Exceedingly Rare Disease. Clin Infect Dis. 2018;66(S1):S92-4. DOI:10.1093/cid/cix818
19. Antonucci L, Locci C, Schettini L, et al. Infant botulism: an underestimated threat. Infect Dis (Lond). 2021;53(9):647-60. DOI:10.1080/23744235.2021.1919753
20. Panditrao MV, Dabritz HA, Kazerouni NN, et al. Descriptive Epidemiology of Infant Botulism in California: The First 40 Years. J Pediatr.
2020;227:247-57.e3. DOI:10.1016/j.jpeds.2020.08.013
21. Arnon SS, Midura TF, Damus K, et al. Honey and other environmental risk factors for infant botulism. J Pediatr. 1979;94(2):331-6. DOI:10.1016/s0022-3476(79)80863-x
22. Tanzi MG, Gabay MP. Association between honey consumption and infant botulism. Pharmacotherapy. 2002;22(11):1479-83. DOI:10.1592/phco.22.16.1479.33696
23. Maikanov B, Mustafina R, Auteleyeva L, et al. Clostridium botulinum and Clostridium perfringens Occurrence in Kazakh Honey Samples. Toxins (Basel). 2019;11(8):472. DOI:10.3390/toxins11080472
24. Bamumin A, Bamumin S, Ahmadini HA, et al. Knowledge, attitude and practice among mothers on the relationship between honey and botulism in Saudi Arabian infants: a cross-section study. Ann Med. 2023;55(2):2279746. DOI:10.1080/07853890.2023.2279746
25. Derman Y, Korkeala H, Salo E, et al. Infant botulism with prolonged faecal excretion of botulinum neurotoxin and Clostridium botulinum for 7 months. Epidemiol Infect. 2014;142(2):335-9. DOI:10.1017/S0950268813001258
26. Douillard FP, Derman Y, Woudstra C, et al. Genomic and Phenotypic Characterization of Clostridium botulinum Isolates from an Infant Botulism Case Suggests Adaptation Signatures to the Gut. mBio. 2022;13(3):e0238421. DOI:10.1128/mbio.02384-21
27. Smith TJ, Williamson CHD, Hill KK, et al. The Distinctive Evolution of orfX Clostridium parabotulinum Strains and Their Botulinum Neurotoxin Type A and F Gene Clusters Is Influenced by Environmental Factors and Gene Interactions via Mobile Genetic Elements. Front Microbiol. 2021;12:566908. DOI:10.3389/fmicb.2021.566908
28. Скрябина А.А., Голенок Е.С., Собх М.М., Никифоров В.В. Строение и механизм действия нейротоксинов ботулизма и столбняка: научный обзор. Эпидемиология и инфекционные болезни. 2023;28(2):118-27 [Skryabina AA, Golenok ES, Sobkh MM, Nikiforov VV. Structure and mechanism of action of botulinum and tetanus neurotoxins: A review. Epidemiology and Infectious Diseases. 2023;28(2):118-27 (in Russian)]. DOI:10.17816/EID321328
29. Rasetti-Escargueil C, Lemichez E, Popoff MR. Toxemia in Human Naturally Acquired Botulism. Toxins (Basel). 2020;12(11):716. DOI:10.3390/toxins12110716
30. Rosow LK, Strober JB. Infant botulism: review and clinical update. Pediatr Neurol. 2015;52(5):487-92. DOI:10.1016/j.pediatrneurol.2015.01.006
31. Rawson AM, Dempster AW, Humphreys CM, Minton NP. Pathogenicity and virulence of Clostridium botulinum. Virulence. 2023;14(1):2205251. DOI:10.1080/21505594.2023.2205251
32. Marchand-Pauvert V, Aymard C, Giboin LS, et al. Beyond muscular effects: depression of spinal recurrent inhibition after botulinum neurotoxin A. J Physiol. 2013;591(4):1017-29. DOI:10.1113/jphysiol.2012.239178
33. Keet CA, Fox CK, Margeta M, et al. Infant botulism, type F, presenting at 54 hours of life. Pediatr Neurol. 2005;32(3):193-6. DOI:10.1016/j.pediatrneurol.2004.09.003
34. Griese SE, Kisselburgh HM, Bartenfeld MT, et al. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. Clin Infect Dis. 2017;66(suppl_1):S17-29. DOI:10.1093/cid/cix812
35. Francisco AM, Arnon SS. Clinical mimics of infant botulism. Pediatrics. 2007;119(4):826-8. DOI:10.1542/peds.2006-0645
36. Khouri JM, Payne JR, Arnon SS. More Clinical Mimics of Infant Botulism. J Pediatr. 2018;193:178-82. DOI:10.1016/j.jpeds.2017.09.044
37. Thompson JA, Glasgow LA, Warpinski JR, Olson C. Infant botulism: clinical spectrum and epidemiology. Pediatrics. 1980;66(6):936-42.
38. Payne JR, Khouri JM, Jewell NP, Arnon SS. Efficacy of Human Botulism Immune Globulin for the Treatment of Infant Botulism: The First 12 Years Post Licensure. J Pediatr. 2018;193:172-7. DOI:10.1016/j.jpeds.2017.10.035
39. Pifko E, Price A, Sterner S. Infant botulism and indications for administration of botulism immune globulin. Pediatr Emerg Care.
2014;30(2):120-4;quiz 125-7. DOI:10.1097/PEC.0000000000000079
40. Vanella de Cuetos EE, Fernandez RA, Bianco MI, et al. Equine botulinum antitoxin for the treatment of infant botulism. Clin Vaccine Immunol. 2011;18(11):1845-9. DOI:10.1128/CVI.05261-11
41. Dalen ML, Knudsen PK, Bye K, et al. An infant with acute flaccid pareses. Tidsskr Nor Laegeforen. 2015;135(16):1455-8. DOI:10.4045/tidsskr.14.1419
42. Long SS. Infant botulism. Pediatr Infect Dis J. 2001;20(7):707-9. DOI:10.1097/00006454-200107000-00013
43. Raja SM, Guptill JT, Juel VC, et al. First-in-Human Clinical Trial to Assess the Safety, Tolerability and Pharmacokinetics of Single Doses of NTM-1633, a Novel Mixture of Monoclonal Antibodies against Botulinum Toxin E. Antimicrob Agents Chemother. 2022;66(4):e0173221. DOI:10.1128/aac.01732-21
44. Shi DY, Lu JS, Mao YY, et al. Characterization of a novel tetravalent botulism antitoxin based on receptor-binding domain of BoNTs. Appl Microbiol Biotechnol. 2023;107(10):3205-16. DOI:10.1007/s00253-023-12515-2
45. Brook I. Infant botulism. J Perinatol. 2007;27(3):175-80. DOI:10.1038/sj.jp.7211651
46. Juzans P, Comella JX, Molgo J, et al. Nerve terminal sprouting in botulinum type-A treated mouse levator auris longus muscle. Neuromuscul Disord. 1996;6(3):177-85. DOI:10.1016/0960-8966(96)00041-7
________________________________________________
1. Ibatullin RA, Magjanov RV. Case of iatrogenic botulism after botulinotherapy in clinical practice. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(11):102-4 (in Russian). DOI:10.26442/terarkh20189011102-104
2. Malov VA, Maleyev VV, Pokrovsky VI. Botulinum toxin therapy and iatrogenic botulism: view of an infectious disease specialist. Infectious Diseases. 2019;17(4):55-61 (in Russian). DOI:10.20953/1729-9225-2019-4-55-61
3. Nikiforov VV. Botulizm. Moscow: Eko-Vektor, 2024 (in Russian).
4. Sobel J. Botulism. Clin Infect Dis. 2005;41(8):1167-73. DOI:10.1086/444507
5. Harris RA, Anniballi F, Austin JW. Adult Intestinal Toxemia Botulism. Toxins (Basel). 2020;12(2):81. DOI:10.3390/toxins12020081
6. Andreeva AA, Kutishcheva IA, Martynova GP, et al. Case of infant botulism. Children's Infections. 2020;19(2):64-6 (in Russian). DOI:10.22627/2072-8107-2020-19-2-64-66
7. King LA, Popoff MR, Mazuet C, et al. [Infant botulism in France, 1991–2009. Arch Pediatr. 2010;17(9):1288-92 (in French)]. DOI:10.1016/j.arcped.2010.06.010
8. López-Laso E, Roncero-Sánchez-Cano I, Arce-Portillo E, et al. Infant botulism in Andalusia (Southern Spain). Eur J Paediatr Neurol. 2014;18(3):321-6. DOI:10.1016/j.ejpn.2013.12.008
9. Vosloo MN, Opperman CJ, Geyer HDW, et al. First confirmed case of infant botulism in Africa, caused by a dual-toxin-producing Clostridium botulinum strain. Int J Infect Dis. 2021;103:164-6. DOI:10.1016/j.ijid.2020.11.131
10. Nga TT, Hoang LH, Trang LT, et al. First confirmed case of infant botulism caused by Clostridium botulinum type A(B) in a 10-month-old infant in Hanoi, Vietnam. IJID Reg.
2022;5:18-20. DOI:10.1016/j.ijregi.2022.08.003
11. Goldberg B, Danino D, Levinsky Y, et al. Infant Botulism, Israel, 2007–2021. Emerg Infect Dis. 2023;29(2):235-41. DOI:10.3201/eid2902.220991
12. Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med. 1976;295(14):770-2. DOI:10.1056/NEJM197609302951407
13. Arnon SS, Werner SB, Faber HK, Farr WH. Infant botulism in 1931. Discovery of a misclassified case. Am J Dis Child.
1979;133(6):580-2. DOI:10.1001/archpedi.1979.02130060020002
14. Nevas M, Lindström M, Virtanen A, et al. Infant botulism acquired from household dust presenting as sudden infant death syndrome. J Clin Microbiol. 2005;43(1):511-3. DOI:10.1128/JCM.43.1.511-513.2005
15. Dilena R, Pozzato M, Baselli L, et al. Infant botulism: checklist for timely clinical diagnosis and new possible risk factors originated from a case report and literature review. Toxins (Basel). 2021;13(12):860. DOI:10.3390/toxins13120860
16. Poulain B, Popoff MR. Why Are Botulinum Neurotoxin-Producing Bacteria So Diverse and Botulinum Neurotoxins So Toxic? Toxins (Basel). 2019;11(1):34. DOI:10.3390/toxins11010034
17. Rossetto O, Montecucco C. Tables of Toxicity of Botulinum and Tetanus Neurotoxins. Toxins (Basel). 2019;11(12):686. DOI:10.3390/toxins11120686
18. Halpin AL, Khouri JM, Payne JR, et al. Type F Infant Botulism: Investigation of Recent Clusters and Overview of This Exceedingly Rare Disease. Clin Infect Dis. 2018;66(S1):S92-4. DOI:10.1093/cid/cix818
19. Antonucci L, Locci C, Schettini L, et al. Infant botulism: an underestimated threat. Infect Dis (Lond). 2021;53(9):647-60. DOI:10.1080/23744235.2021.1919753
20. Panditrao MV, Dabritz HA, Kazerouni NN, et al. Descriptive Epidemiology of Infant Botulism in California: The First 40 Years. J Pediatr.
2020;227:247-57.e3. DOI:10.1016/j.jpeds.2020.08.013
21. Arnon SS, Midura TF, Damus K, et al. Honey and other environmental risk factors for infant botulism. J Pediatr. 1979;94(2):331-6. DOI:10.1016/s0022-3476(79)80863-x
22. Tanzi MG, Gabay MP. Association between honey consumption and infant botulism. Pharmacotherapy. 2002;22(11):1479-83. DOI:10.1592/phco.22.16.1479.33696
23. Maikanov B, Mustafina R, Auteleyeva L, et al. Clostridium botulinum and Clostridium perfringens Occurrence in Kazakh Honey Samples. Toxins (Basel). 2019;11(8):472. DOI:10.3390/toxins11080472
24. Bamumin A, Bamumin S, Ahmadini HA, et al. Knowledge, attitude and practice among mothers on the relationship between honey and botulism in Saudi Arabian infants: a cross-section study. Ann Med. 2023;55(2):2279746. DOI:10.1080/07853890.2023.2279746
25. Derman Y, Korkeala H, Salo E, et al. Infant botulism with prolonged faecal excretion of botulinum neurotoxin and Clostridium botulinum for 7 months. Epidemiol Infect. 2014;142(2):335-9. DOI:10.1017/S0950268813001258
26. Douillard FP, Derman Y, Woudstra C, et al. Genomic and Phenotypic Characterization of Clostridium botulinum Isolates from an Infant Botulism Case Suggests Adaptation Signatures to the Gut. mBio. 2022;13(3):e0238421. DOI:10.1128/mbio.02384-21
27. Smith TJ, Williamson CHD, Hill KK, et al. The Distinctive Evolution of orfX Clostridium parabotulinum Strains and Their Botulinum Neurotoxin Type A and F Gene Clusters Is Influenced by Environmental Factors and Gene Interactions via Mobile Genetic Elements. Front Microbiol. 2021;12:566908. DOI:10.3389/fmicb.2021.566908
28. Skryabina AA, Golenok ES, Sobkh MM, Nikiforov VV. Structure and mechanism of action of botulinum and tetanus neurotoxins: A review. Epidemiology and Infectious Diseases. 2023;28(2):118-27 (in Russian). DOI:10.17816/EID321328
29. Rasetti-Escargueil C, Lemichez E, Popoff MR. Toxemia in Human Naturally Acquired Botulism. Toxins (Basel). 2020;12(11):716. DOI:10.3390/toxins12110716
30. Rosow LK, Strober JB. Infant botulism: review and clinical update. Pediatr Neurol. 2015;52(5):487-92. DOI:10.1016/j.pediatrneurol.2015.01.006
31. Rawson AM, Dempster AW, Humphreys CM, Minton NP. Pathogenicity and virulence of Clostridium botulinum. Virulence. 2023;14(1):2205251. DOI:10.1080/21505594.2023.2205251
32. Marchand-Pauvert V, Aymard C, Giboin LS, et al. Beyond muscular effects: depression of spinal recurrent inhibition after botulinum neurotoxin A. J Physiol. 2013;591(4):1017-29. DOI:10.1113/jphysiol.2012.239178
33. Keet CA, Fox CK, Margeta M, et al. Infant botulism, type F, presenting at 54 hours of life. Pediatr Neurol. 2005;32(3):193-6. DOI:10.1016/j.pediatrneurol.2004.09.003
34. Griese SE, Kisselburgh HM, Bartenfeld MT, et al. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. Clin Infect Dis. 2017;66(suppl_1):S17-29. DOI:10.1093/cid/cix812
35. Francisco AM, Arnon SS. Clinical mimics of infant botulism. Pediatrics. 2007;119(4):826-8. DOI:10.1542/peds.2006-0645
36. Khouri JM, Payne JR, Arnon SS. More Clinical Mimics of Infant Botulism. J Pediatr. 2018;193:178-82. DOI:10.1016/j.jpeds.2017.09.044
37. Thompson JA, Glasgow LA, Warpinski JR, Olson C. Infant botulism: clinical spectrum and epidemiology. Pediatrics. 1980;66(6):936-42.
38. Payne JR, Khouri JM, Jewell NP, Arnon SS. Efficacy of Human Botulism Immune Globulin for the Treatment of Infant Botulism: The First 12 Years Post Licensure. J Pediatr. 2018;193:172-7. DOI:10.1016/j.jpeds.2017.10.035
39. Pifko E, Price A, Sterner S. Infant botulism and indications for administration of botulism immune globulin. Pediatr Emerg Care.
2014;30(2):120-4;quiz 125-7. DOI:10.1097/PEC.0000000000000079
40. Vanella de Cuetos EE, Fernandez RA, Bianco MI, et al. Equine botulinum antitoxin for the treatment of infant botulism. Clin Vaccine Immunol. 2011;18(11):1845-9. DOI:10.1128/CVI.05261-11
41. Dalen ML, Knudsen PK, Bye K, et al. An infant with acute flaccid pareses. Tidsskr Nor Laegeforen. 2015;135(16):1455-8. DOI:10.4045/tidsskr.14.1419
42. Long SS. Infant botulism. Pediatr Infect Dis J. 2001;20(7):707-9. DOI:10.1097/00006454-200107000-00013
43. Raja SM, Guptill JT, Juel VC, et al. First-in-Human Clinical Trial to Assess the Safety, Tolerability and Pharmacokinetics of Single Doses of NTM-1633, a Novel Mixture of Monoclonal Antibodies against Botulinum Toxin E. Antimicrob Agents Chemother. 2022;66(4):e0173221. DOI:10.1128/aac.01732-21
44. Shi DY, Lu JS, Mao YY, et al. Characterization of a novel tetravalent botulism antitoxin based on receptor-binding domain of BoNTs. Appl Microbiol Biotechnol. 2023;107(10):3205-16. DOI:10.1007/s00253-023-12515-2
45. Brook I. Infant botulism. J Perinatol. 2007;27(3):175-80. DOI:10.1038/sj.jp.7211651
46. Juzans P, Comella JX, Molgo J, et al. Nerve terminal sprouting in botulinum type-A treated mouse levator auris longus muscle. Neuromuscul Disord. 1996;6(3):177-85. DOI:10.1016/0960-8966(96)00041-7
1ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия; 2ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия; 3ФГБОУ ВО «Ижевская государственная медицинская академия» Минздрава России, Ижевск, Россия
*valmalov@list.ru
________________________________________________
Valeri A. Malov*1, Viktor V. Maleev2, Vladimir P. Chulanov1, Denis S. Sarksyan3
1Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 2Central Research Institute of Epidemiology, Moscow, Russia; 3Izhevsk State Medical Academy, Izhevsk, Russia
*valmalov@list.ru